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Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled
Margaret Waltz1, Haoyang Yan2, R Jean Cadigan1
1Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
Insights
Pre-visit preparation (PVP) with question prompt lists (QPLs) increased caregiver questions in genetic appointments. However, this intervention was less effective for underserved populations, highlighting the need for broader engagement strategies.
Area of Science:
- Medical Genetics
- Health Services Research
- Patient Engagement
Background:
- Shared decision-making in healthcare relies on effective patient involvement and question-asking.
- Question prompt lists (QPLs) have demonstrated success in enhancing patient engagement during medical appointments.
- Caregivers of pediatric patients with undiagnosed genetic conditions face unique challenges in seeking information and participating in decision-making.
Purpose of the Study:
- To evaluate the effectiveness of pre-visit preparation (PVP), incorporating QPLs, in increasing question-asking among caregivers of pediatric patients with suspected genetic conditions.
- To determine if PVP influences the number of total questions and QPL-specific questions asked by caregivers.
- To explore potential disparities in the intervention's effectiveness across different socioeconomic or insurance groups.
Main Methods:
- A randomized controlled trial was conducted with caregivers of pediatric patients with suspected genetic conditions.
- Participants were assigned to either a pre-visit preparation (PVP) group or a control group.
- Audio recordings of appointments were analyzed to quantify the number of questions asked by caregivers.
Main Results:
- Caregivers in the PVP group asked significantly more questions overall compared to the control group (p=0.045).
- The PVP group also asked more QPL-specific questions (p=0.002).
- The intervention showed a greater effect for caregivers whose children had insurance other than Medicaid, with no significant effect observed for Medicaid or uninsured groups.
Conclusions:
- Pre-visit preparation, including QPLs, can enhance caregiver question-asking in pediatric genetics appointments.
- The effectiveness of this intervention may be limited in traditionally underserved populations, suggesting potential equity concerns.
- Further research and provider-focused strategies are necessary to ensure equitable patient engagement for all populations.
Objective:
Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions.
Methods:
Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked.
Results:
Caregivers in the PVP group asked more questions (MeanPVP = 4.36, SDPVP = 4.66 vs. Meancontrol = 2.83, SDcontrol = 3.03, p = 0.045), including QPL questions (MeanPVP = 1.05, SDPVP = 1.39 vs. Meancontrol = 0.36, SDcontrol = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166).
Conclusion:
The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients.
Practice Implications:
Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement.
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